Keele University

Ankle fractures are common injuries, with a significant proportion requiring surgical intervention. Despite established treatment principles, the optimal timing for open reduction and internal fixation (ORIF) remains debated. Concerns regarding wound infection risk have led some surgeons to delay fixation, while others advocate for early intervention. This study aimed to assess the impact of surgical timing on postoperative wound infections. A retrospective review was conducted on 1130 patients with surgically treated closed ankle fractures at a single institution between 2000 and 2022. Patients were categorised into three groups based on time to surgery: Early (<48h), Intermediate (48h to 5 days), and Delayed (>5 days) with timing determined pragmatically according to soft-tissue condition, theatre availability, and both surgeon and patient preference. Postoperative complications, including superficial and deep wound infections, were recorded. The chi-squared test was used to assess associations between surgical timing and infection rates. There was no significant association between surgical timing and the incidence of superficial wound infections (p=0.274). However, a significant difference was observed in deep wound infection rates (p=0.014). Diabetes, particularly Type 1, was significantly associated with both superficial (p<0.001) and deep infections (p=0.019). Patients over 60 years had an increased risk of superficial infections (p=0.016) but not deep infections (p=0.261). Superficial wound infections required longer hospital stay (p<0.001) due to the need for intravenous antibiotics and monitoring purposes, while the number of procedures significantly correlated with both superficial (p<0.001) and deep infections (p<0.001). In this study, the timing to surgery did not influence postoperative superficial wound infection rates following ORIF for ankle fractures. However, differences were observed in deep wound infection rates. Patient-related factors including diabetes and age are predictors of wound complications. Length of hospital stay was longer in patients with infections. IV.

To investigate changes in the prevalence of chronic pain (CP), high-impact chronic pain (HICP), and musculoskeletal health (MSK-HQ scores) before and after the COVID-19 pandemic. Longitudinal cross-sectional study using data from two population-based surveys conducted in 2016/17 (PRELIM) and 2022/23 (MIDAS-POP). Adults aged 35 and over registered with general practices in the West Midlands, UK, completed questionnaires including CP, HICP, and MSK-HQ. Entropy balancing was applied to match respondents across survey years on age, sex, deprivation, and ethnicity. Logistic and linear regressions estimated odds ratios (ORs) and mean differences. Subgroup analyses tested for interactions, and E-values were calculated to assess robustness to unmeasured confounding. CP prevalence increased from 35.6% in 2016/17 to 42.9% in 2022/23 (OR 1.36, 95% CI 1.22 to 1.51), and HICP from 15.5% to 22.4% (OR 1.57, 1.38 to 1.80). MSK-HQ scores among people with CP declined from 32.4 to 23.1, exceeding the minimal important change. Increases were more marked among women and people aged 35-54. Differences by deprivation and ethnicity were observed, although subgroup estimates for ethnicity should be interpreted cautiously due to small sample sizes. E-values suggested that the associations were moderately robust to unmeasured confounding. Chronic pain prevalence and its burden have increased since the COVID-19 pandemic, alongside declines in musculoskeletal health. While some of this may reflect residual confounding, the findings underscore the need for targeted pain prevention and management strategies, particularly for working-age adults and underserved groups.

Abstract We report a multi-epoch V-band campaign (2021–2023) with uniform processing and a common 550 km normalisation across Starlink generations. Median magnitudes (68% confidence intervals; N in brackets) are: v1.0: 5.365,[5.084,5.553] (34), Gen-2: 6.012,[5.801,6.173] (6), v1.5: 6.106,[6.065,6.154] (164), VisorSat: 6.618,[6.403,6.804] (54), DarkSat: 8.431,[5.916,10.947] (2). This yields the ordering v1.0 &amp;lt; Gen-2 ≲ v1.5 &amp;lt; VisorSat ≪ DarkSat, i.e. mitigation-era designs are typically fainter than the original v1.0. The Gen-2–v1.5 difference is small (0.094,mag) and Gen-2 has limited coverage (N = 6), so the trend is not strictly monotonic. We use an open, Python-based processing pipeline built on astropy for standard image calibration (bias, dark and flat-field correction), astrometric and photometric calibration against Gaia DR3, and derivation of the viewing geometry (solar phase angle, range, elongation and airmass). Satellite tracks are identified from TLE-based ephemerides, matched to the detections, and then used to measure a brightness value for each track in a reproducible way. At a common height, the medians are 5.37 (v1.0), 6.01 (Gen-2), 6.11 (v1.5), 6.62 (VisorSat) and 8.43 (DarkSat; N = 2), which are ∼0.4–1.6 mag brighter (numerically smaller) than the target of V ≈ 7. Thus, mitigation shows clear progress but does not yet meet the IAU CPS/SATCON goal of V ≥ 7 at ∼550 km. These benchmarks can guide future satellite designs, survey planning and avoidance strategies, with the main uncertainties arising from the very small samples for DarkSat and Gen-2.

This study compared the clinical outcomes of the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations for the management of acute midsubstance Achilles tendon ruptures (AMATR). A retrospective analysis was conducted on 63 AMATR patients (54 men and 9 women, with a mean age of 39.84 ± 10.40 years (range, 21-62 years). All patients underwent Achilles tendon repair using the modified Bunnell suture configuration using the all-inside endoscopic repair (n = 31) or a minimally invasive repair (n = 32). The primary endpoint was postoperative functional outcome, assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) score and the Achilles Tendon Total Rupture Score (ATRS) at 6, 12, and 24 months. Secondary endpoints included perioperative and short-term recovery parameters, including operative time, incision length, postoperative pain assessed by the Visual Analog Scale (VAS) on postoperative days 1 and 3, wound complications, and time to return to work and sports activities. There were no intraoperative complications, and all patients in the endoscopic group achieved primary wound healing. At the 6-, 12-, and 24-month follow-up, both groups demonstrated significant improvement in AOFAS and ATRS scores over time, with no significant differences between groups. Regarding secondary endpoints, the all-inside endoscopic group had a significantly longer operative time but a significantly shorter incision length compared with the minimally invasive group (p < 0.05). VAS pain scores on postoperative days 1 and 3 were significantly lower in the endoscopic group (p < 0.05). No wound infections occurred in the endoscopic group, whereas three superficial infections were observed in the minimally invasive group; however, the difference was not statistically significant. Patients in the endoscopic group returned to work one week earlier (p < 0.05), while the time to return to sports was comparable between groups. Both the all-inside endoscopic and the minimally invasive modified Bunnell suture configurations provide reliable repair for AMATR and support a successful return to occupational and athletic activity. While the all-inside endoscopic procedure was associated with a longer operative time, it offered advantages in terms of reduced early postoperative pain, smaller incisions, and earlier return to work, without compromising functional recovery at the 2-year follow-up.

Bibliometric analyses are increasingly used to explore how scientific knowledge is created, disseminated, and perceived. In orthopaedics, research output has expanded rapidly over the past decade, yet the factors determining whether an article achieves wide visibility and scholarly impact remain poorly understood. Beyond the inherent quality of a study, elements such as authorship patterns, title construction, and open access (OA) availability may play an essential role in shaping citation performance. However, evidence in this field is still limited and sometimes contradictory, highlighting the need for large-scale, field-specific analyses. Orthopaedic publications from 2010 to 2020 were identified in Scopus using the keyword 'orthopaedic'. After duplicate removal, 97,806 unique articles were included with complete data on authorship, titles, citation counts, study design, and OA status. Citation rates were normalised per year since publication. Associations between bibliographic features and citation performance were assessed using multiple linear regression, while differences across title styles and study designs were evaluated with comparative statistical testing. Exploratory modelling was performed to identify combinations of authorship and title characteristics linked to the highest predicted citation rates. Larger author teams were associated with higher citation rates (β = 0.108 citations/year per additional author, 95% confidence interval [CI] 0.103-0.114, p < 0.001). OA articles achieved a mean increase of 0.175 citations/year compared with non-OA (p = 0.001). Title length in characters correlated positively with citation rate (β = 0.023 per character, p < 0.001), whereas title length in words showed a negative association (β = -0.183 per word, p < 0.001). The presence of a colon (+0.314 citations/year, p < 0.001) or dash (+0.187, p = 0.001) increased citation performance, while question marks (-0.476, p < 0.001) and all-capital titles (mean 0.71 citations/year) reduced it. Regarding study design, network meta-analyses achieved the highest citation rate (mean 6.64 citations/year), followed by systematic reviews (5.66), meta-analyses (5.08) and narrative reviews (4.81). Randomised controlled trials (3.90) and clinical trials (3.86) performed at an intermediate level, whereas observational studies (2.40), case series (1.79), technical notes (1.33), case reports (0.77), editorials (0.51) and commentaries (0.25) showed consistently lower citation performance (p < 0.0001). In orthopaedic research, collaboration, OA availability and concise, well-structured titles with selected punctuation contribute to higher citation performance, while unconventional title formatting reduces visibility. Although useful for optimising dissemination, ethical authorship practices and rigorous scientific standards remain more critical than citation metrics.

Standard modifiable risk factors (SMuRFs) are associated with increased risk of acute myocardial infarction (AMI). Patients with AMI in the absence of standard modifiable risk factors (SMuRF-less) have demonstrated excess mortality. The study aims to forecast trends in prevalence and case fatality of SMuRF-less AMI in Singapore and United Kingdom. Data from the Singapore Myocardial Infarction Registry and the UK Myocardial Ischemia National Audit Project were used to construct Poisson regression models to predict the prevalence and case fatality rate of SMuRF-less AMI from 2025 to 2040. From 2025 to 2040, SMuRF-less AMI cases are expected to contribute to larger proportions of total AMI cases in Singapore (5.8% [95% CI: 5.2%-6.4%] to 8.5% [95% CI: 6.2%-10.8%]) and United Kingdom (13.8% [95% CI: 13.0%-14.6%] to 16.9% [95% CI: 15.1%-18.7%]). The proportion of SMuRF-less AMI mortality of the total AMI mortality is set to decrease in the United Kingdom (11.3% [95% CI: 10.5%-12.1%] to 9.5% [95% CI: 7.7%-11.4%]), but increase in Singapore (6.3% [95% CI: 5.7%-6.9%] to 13.3% [95% CI: 10.9%-15.6%]). Men continue to bear the majority of SMuRF-less AMI prevalence, with the most rapid rise in young adults in Singapore (8.1%; 95% CI: 7.5%-8.7%) and middle-aged adults in the United Kingdom (2.3%; 95% CI: 1.5%-3.1%). The increase in SMuRF-less AMI prevalence is set to be more rapid in the overweight/obesity population (3.9%; 95% CI: 3.3%-4.5%). By 2040, SMuRF-less AMI will expand to a larger proportion of the AMI census in Western and Eastern populations. SMuRF-less AMI vulnerability will shift toward a younger, male-dominant demographic, with overweight/obesity as a dominant risk factor.

Marginal-marine successions deposited in restricted basins under arid conditions are characterised by complex interplay between variable hydrodynamic conditions, localised carbonate-evaporitic production and continental surface processes. In such scenario, climatically driven shifts of depositional belts may result in stratigraphic compartmentalisation through vertical facies and environments dislocation. As importantly, accommodation variations across marine margins can lead to preferential deposition of coeval systems which may ultimately translate into stratigraphic sealing through lateral facies transition. By deciphering the relative influence of allogenic controls upon marine margins stratigraphic architectures in arid and restricted settings and by documenting their sedimentary products, this work provides a generalised sequence stratigraphic model for arid epicratonic basin fills.Stratigraphic arrangement of mixed paralic deposits is investigated across two margin-perpendicular transects of the Middle to Upper Jurassic San Rafael Group in Utah. Transgressive sequences of the Carmel and the Curtis formations deposited during flooding events of the Sundance Sea are intercalated between the aeolian- to fluvially-dominated low stand deposits of the Entrada Sandstone and the Summerville Formation. Facies changes and sequence stratigraphic surfaces are documented through detailed sedimentary logging and architectural panel interpretations at locations representative of 1) sediment-supply and accommodation controlled continental basin flanks; 2) autogenically overprinted paralic basin margin settings; 3) climatically controlled basin centre. Gamma-ray log data were collected in parts of the basin characterised by differing tectonics settings.Successions deposited during transgressions are dominantly associated with complex tidal embayments reworking contemporaneous continental sediment deposited further inland and may present contrasting architectural and lithological characteristics linked to variability in basin physiographic settings and climatic conditions. Transgression sequences are generally recorded as composite surfaces in continental basin flank settings although thin fluvial deposits may locally be preserved in the case of favourable accommodation and sediment supply conditions. Sedimentary successions deposited during relative sea-/base-level low stands are characterised by the advance of aeolian systems during aridity maximums and translate basinward to coastal unconfined large-scale alluvial accretion successions. Maximum regression surfaces are associated with terminations of aeolian dune fields. High-frequency climatic fluctuations are preferentially recorded in continental basin flank settings during regressive trends as aeolian dune field growth stages bounded by deflationary supersurfaces. Larger-scale T-R sequential frameworks and their associated spatio-temporal facies evolution are more likely to be controlled by overarching changes in rates of accommodation creation due to foreland basin tectonics. By incorporating spatial facies variations within stacking trends at a basin scale, the proposed model highlights the architectural complexity and facies diversity of depositional sequences within arid epicratonic basins and may constrain reservoir characteristics and associated stratigraphic heterogeneities.

Sedimentologika (e-ISSN 2813-415X) is the community-driven, Diamond Open Access scientific journal dedicated to advancing the field of sedimentology. As a Diamond Open Access journal, the content is freely available to read and share, and the journal is free to publish in.Sedimentologika is an international, broad-scope journal that publishes high-quality scientific research on sedimentology, stratigraphy, and related fields. The journal accepts research with widely applicable advances in sedimentology, as well as regional case studies of interest to the sedimentology community, regardless of spatial and temporal scales, on Earth or any other planetary body. It also encourages interdisciplinary studies that link sedimentology to geochemistry, palaeontology, microbiology, archaeology, geomorphology, meteorology, hydrology, paleoclimate, tectonics (amongst others), and transdisciplinary studies that encompass sedimentology in society, education, and technology. Finally, Sedimentologika also aims to foster an inclusive and diverse environment within sedimentology, stratigraphy, and related fields (Thomas et al., 2023).Since its opening in fall 2022, it has published 4 issues and is growing slowly in the sedimentary sciences field. Its growth compares with other newly created and scholarly-led Diamond open access journals, reflecting a community that relies on society journals operating under hybrid or gold open access managed by large for profit publishing companies. While the growth is satisfactory in such environments, it relies on the increasing contribution of researchers, in a system where not all country value the inputs of scholarly-led ventures without impact factor, and where scientific publishing is seen more and more as a service, and less as a joint effort to strenghten a scientific field. In this way, reconsidering editorial, reviewing and copyediting contributions as part of an added value for a scholar career is essential and necessary if fairer modes of publications are to be achieved in a near future. Thomas, C., Privat, A., Vaucher, R., Spychala, Y., Zuchuat, V., Marchegiano, M., Poyatos-Moré, M., Kane, I., &amp; Chiarella, D. 2023: Sedimentologika : A community-driven diamond open access journal in sedimentology. Sedimentologika, 1.

Abstract The primary aim is to develop a model that can achieve high accuracy in solving multi label classification problems by training, testing, and analyzing deep learning models that utilize both image and text data. In this paper, we propose a novel hybrid model that jointly considers textual and visual data for the task of movie genre prediction, which is a representative example of multi label classification problems. In the proposed model, textual features extracted from movie summaries are obtained using the DistilBERT model, while visual features derived from movie posters are extracted using the ConvNeXt deep learning model. These features from the two modalities are then combined using the XGBoost machine learning algorithm to perform genre prediction. This approach aims to achieve higher accuracy and better generalizability in movie genre classification by integrating information from different modalities through a late fusion method. The ConvNeXt architecture was adapted to the problem using transfer learning and fine-tuning techniques. To achieve the highest performance from the DistilBERT model, optimization was performed for the token length and threshold hyperparameters, and the model with a token length of 256 and a threshold of 0.5 was used in the hybrid model. Furthermore, to maximize the overall performance of the novel hybrid model, optimization was conducted using the Grid Search algorithm. All three proposed models were trained and tested on a dataset obtained from the IMDB website. The performances of the models were evaluated using hamming loss, precision and F1 score metrics. Experimental results revealed that, overall, the text-based model outperformed the image-based model, while the proposed hybrid model achieved higher performance than both individual models. It was demonstrated that textual and visual features complement each other and positively enhance the overall performance. This paper presents an original and effective study for multi label movie genre classification, combining the fields of computer vision, natural language processing, and machine learning.

<h3>Introduction</h3> Validated grief tools help assess and support bereaved populations, but there are currently no suitable tools for use with young children and children with Special Educational Needs (SEN). <h3>Aim</h3> To develop a pictorial version of the Children’s Attitude to Grief (CAG) Scale for use with young children and children with SEN. <h3>Methods</h3> We conducted a scoping review of grief and mental health tools which use non-verbal methods, followed by an online workshop with child bereavement and SEN practitioners, academic/researchers, an illustrator and public representative. Review findings were discussed in relation to the main CAG scale and associated Range of Response to Loss (RRL) model, with changes suggested to improve accessibility, alongside ideas for visual representations. Through an iterative design and review process involving the research team, practitioners and illustrator, alongside child feedback on draft illustrations, we created a pictorial version of the scale which is now being piloted. <h3>Results</h3> A number of modifications were made to the main CAG scale. Structurally, the order of the nine questions was changed to give flow to the grief ‘story’, based on three subgroups of questions: thinking; feeling, and a changed world. Narrative explanations precede each question, with focus directed towards pictures depicting the overwhelmed, controlled and resilient RRL concepts. Direct (do you..?) questions are used to assess each concept, and a reduced three-point scale captures responses, with beakers used to visualise the options ‘yes-a lot’, ‘yes-a bit’, ‘no-not at all.’ To aid identification, gender neutral images have been used centring around a child named ‘Sam’, who experienced the same type of (modifiable) loss as the child receiving support. <h3>Conclusion/Impact</h3> The CAG-P is the first pictorial grief scale designed for use with bereaved young children and older children with SEN. We anticipate widespread Impact on these populations and those working with them.